It's time to try new approach to health care

October 08, 2004|By Steve Chapman

CHICAGO - Politicians used to run for office promising to fix the health care crisis, but lately they've given up pretending they have any answers. Since 2000, medical costs have soared and the number of people without medical insurance has grown. Yet the issue has been almost invisible in this presidential campaign.

As it happens, both George W. Bush and John Kerry have some proposals, which consist mainly of measures to increase the number of Americans with medical coverage. Mr. Bush wants to rely on tax credits, while Mr. Kerry hopes to reduce insurance premiums by making the government pick up some of the costs of catastrophic illness.

Unfortunately, neither addresses the maddening dilemma we face. Anything you do to expand access to health care, such as making insurance more available, increases the demand for health care and, in turn, drives up the price of health care. But if you try to control the cost of health care, you make it less accessible by discouraging hospitals and doctors from providing it. Politicians can't figure out a way to ameliorate both problems at once, so they end up doing little or nothing, or take steps that are likely to make things worse.

But there is a way to advance both worthy goals simultaneously - one that has been almost completely overlooked. Instead of focusing on demand, we could take steps to expand supply and promote competition. Like a glut in the gasoline market, that would allow people to consume more without all of us spending more.

Medicine is one of the most tightly regulated sectors in the entire economy, and many of the regulations limit supply. We require doctors to spend at least seven years in training after college, which deters many people from going into medicine. We impose licensing requirements that prevent some trained people from offering care. At the same time, we limit the types of treatment that other medical professionals, such as physician assistants and nurses, may provide.

These policies are supposed to ensure quality, but they also deprive patients of options they might happily choose.

You might think tight regulation is needed to protect patients from quacks. But California State University economist Shirley Svorny notes that while this type of regulation raises costs, studies indicate that "the effect of licensure on consumption quality is ambiguous."

There is plenty of evidence that government policies reduce the availability of medical care. Though chiropractic is now widely used, the medical profession waged a long battle to prevent it from gaining acceptance. Today, the value of spinal manipulation for treating lower back pain, said a 1998 article in The New England Journal of Medicine, is "no longer in dispute." Medicare, however, still declines to cover some treatments that chiropractors are licensed to provide.

That experience should be a lesson about the value of expanding patient options, an approach that could lower costs while increasing satisfaction. It's not the only such lesson. Twenty years ago, midwifery was treated with scorn by medical experts. But a growing body of academic reports indicates that for normal pregnancies, deliveries can be handled as safely by nurse midwives and lay midwives as by obstetricians.

One reason many people find health care inaccessible or too expensive is that we insist on providing so much of it through highly trained physicians. The idea of finding ways to reduce the years of training doesn't seem to have occurred to anyone. Apart from that, nurse practitioners, nurses and physician assistants could do a lot of what we now rely on doctors to do - and at a lower cost. They could also expand access to medical care in poor and rural areas that physicians shun.

It's easy to say everyone should get care from doctors. But that's like saying everyone should drive a Volvo. If we limited consumer choices to one ultra-safe nameplate, many people would not be able to afford a car at all. We let individuals make most of their own choices about safety and cost when it comes to cars - why not with medical care?

For 40 years, every solution to our health care problems has been a variation on the same theme: more government. Maybe the real answer is more freedom.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing newspaper. His column appears Tuesdays and Fridays in The Sun.

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